A growing body of research has explored well-being in diverse cultural contexts, and indicates that the definition and perception of well-being vary according to cultural context. Little is known, however, about whether intercultural differences in China (i.e., Tibetan and Han) lead to different perceptions of well-being and how social contexts and personal characteristics are associated with well-being in Tibetan and Han emerging adults. Using a self-determination framework, the current study examines the relationship between parental autonomy support (PAS) and (...) psychological well-being (PWB) in Tibetan and Han emerging adults in China. Guided by implicit theory and self-regulatory theory, we propose a serial multiple mediation model of growth mindset and grit in the association between PAS and PWB. Propensity score matching was used to balance the two ethnic groups in terms of age, gender, socioeconomic status (SES), with a ratio of one to two. Finally, 59 Tibetan (71.2% girls) and 118 Han (69.5% girls) emerging adults aged from 18 to 25 years were included in the current study, and completed an online questionnaire survey. Findings suggest that (a) Tibetan emerging adults perceived higher levels of PWB than their peers from the Han ethnic group; (b) a serial multiple mediation model for the association between PAS and PWB was supported in Han emerging adults; (c) the indirect effects between PAS and PWB varied between Tibetan and Han emerging adults. Our findings suggest that PAS and grit contribute to PWB of emerging adults in both cultural contexts, whereas growth mindset may be beneficial for Han emerging adults only. (shrink)

Analyzing students’ internal cognitive-motivational appraisals and achievement emotions is of pivotal importance for educational outcomes and student individual wellbeing, yet little is shown about their associations with teacher autonomy support. This study investigates the relationship between perceived teacher autonomy support and reading achievement by addressing mediating influences of control and value-related constructs, i.e., reading self-efficacy, meaning in life, and reading enjoyment. Multiple mediation modeling was adopted to test the proposed model with carrying out a total of (...) 12,058 students from 361 schools in China in the Programme for International Student Assessment 2018 reading database. The results elucidated that student-perceived teacher autonomy support is significantly positively related to adolescents’ reading outcomes by fostering internal control and value appraisals and academic enjoyment. These current findings confirm the positive correlation between teacher autonomy support and adolescents’ motivational and emotional factors, providing significant practical implications for educators to adopt various teaching strategies to enhance adolescents’ self-efficacy, intrinsic values, and positive emotions. (shrink)

The present research examined relationships between parental autonomy support, parental psychological control, and Chinese emerging adults’ autonomous regulation in their university studies as well as dysregulation in social media engagement. A total of 287 Chinese university students reported on their perceived parenting styles, psychological needs, and behavior regulation. Results showed that basic psychological need satisfaction was positively associated with parental autonomy support and autonomous regulation of learning; need frustration was positively correlated with parental psychological control and (...) dysregulation in social media engagement. More importantly, psychological need frustration was a mediator of the relation between parental psychological control and dysregulation in social media engagement. Our findings suggest that students living in an autonomy-supportive familial environment tend to have satisfied psychological needs as well as autonomous learning behavior. Impairment of psychological needs could be one of the mechanisms through which psychologically controlling parenting was linked to dysregulation of social media use in Chinese culture. (shrink)

Guided by the ecosystem theory, this study aimed to explore the association between parental autonomy support and future-oriented coping of high school students, as well as the mediating effects of future time perspective and meaning in life in this relationship. A total of 707 Chinese high school students were involved in a paper questionnaire survey and data analysis. It was found that parental autonomy support was significantly positively related to future-oriented coping. Mediation analyses demonstrated that parental (...) autonomy support directly affects future-oriented coping; parental autonomy support indirectly affects future-oriented coping through separate mediation and serial mediation of future time perspective and meaning in life. These findings have important implications for the improvement of future-oriented coping abilities of high school students. (shrink)

Using the Self-Determination Theory as a framework, this study tests the predictive capacity of the teacher’s interpersonal style of autonomy support at a higher education institution, and the grit on the satisfaction of basic psychological needs, intrinsic motivation, group cohesion, and life satisfaction in university students. A sample composed of 489 Colombian university students, aged between 18 and 41 years, was used; they filled in the questionnaires that measured the variables of interest. After the analysis of structural equations, (...) the results showed that the perception of teaching style of autonomy support and the grit positively predicted the basic psychological needs and these predicted the intrinsic motivation, which in turn predicted group cohesion and satisfaction with life. The model describes the possible importance of promoting the teacher’s interpersonal style of autonomy support within the university setting in the search for satisfaction with life along with the active role of the student through the mediation of the satisfaction of basic psychological needs, increased quality motivation, and high group cohesion. (shrink)

Drawing on the self-determination framework, the study examined the effect of coaches’ autonomy support on the leisure experience of young male football players. Specifically, a model was tested analyzing the long-term predictive power of the players’ perception of coach-autonomy support at the beginning of the season on the subjective vitality of young football players at the end of the season through needs satisfaction and intrinsic motivation. Moreover, we tested whether the effects of coach-autonomy support (...) on the aforementioned variables (needs satisfaction, intrinsic motivation, and subjective vitality) at the end of the season remained at the beginning of the following season. Because the coach in the second season was not the same one as in the first season, the perception of coach-autonomy support at the beginning of the second season was used as a control variable. Three hundred and sixty football players (M age = 12.60 years; SD = 0.52) completed a questionnaire on the variables of interest at the beginning of the first season (T1), at the end of the first season (T2), and at the beginning of the second season (T3). The results of the path analyses showed that player’ perceptions of coach autonomy support at the beginning of the season (T1) positively predicted needs satisfaction at the end of the first season (T2), which in turn predicted intrinsic motivation at the end of the first season (T2). Additionally, intrinsic motivation significantly and positively predicted subjective vitality at the end of the first season (T2). Finally, needs satisfaction, intrinsic motivation, and subjective vitality at the end of the second season (T2) positively predicted these same variables at the beginning of the second season (T3). Results emphasized the importance of the autonomy support offered by the coach in promoting the quality of young people’s leisure experience playing football and its benefits for their well-being. (shrink)

Teachers can expect that autonomy support positively influences students’ affective-emotional perception in physical education, when considering assumptions of the Self-Determination theory. Highly autonomy-supportive PE teaching comprises students’ free choices regarding organizational, procedural, and cognitive aspects of a PE lesson, whereas low autonomy support addresses these aspects only partly and controlling teaching refers to students as recipients of the teacher’s decisions. This quasi-experiment investigates effects to determine the effects of high autonomy-supportive, low autonomy-supportive and (...) controlling PE class teaching styles on affective valence and enjoyment. As such, we compare the effects of these teaching styles on beneficial psychological outcomes in students. In a sample of German students perceived autonomy support, affective valence, and enjoyment were assessed via self-report questionnaires before and after a 20-min PE class intervention focusing on high or low autonomy-supportive, or controlling teaching. Students who participated in PEhigh perceived significantly more positive valence and enjoyment over time compared to students in the PElow and PEcontrol groups. Differences between groups show significant results for valence between PEhigh and PEcontrol, and between PElow and PEcontrol. Thus, PEhigh should be preferred over PElow to intensify these effects. Based on these results, PE teachers can employ a high autonomy-supportive teaching style to improve students’ positive affective-emotional perception and to foster an increase in students’ time engaged in physical activity. (shrink)

This study investigated situational changes in learners’ degree of autonomous regulation during other-initiated learning activities and examined the influence of the instructional style on such changes. To this end, relative autonomous motivation of 172 fifth to seventh grade students was measured before, during and after execution of a musical learning activity. It was experimentally manipulated whether students were instructed in an autonomy-supportive or a controlling style. As expected based on self-determination theory and the action-based model of cognitive dissonance, relative (...) autonomous motivation increased in the course of the execution of the learning activity. Unexpectedly, this increase was only statistically significant when students were instructed in a controlling style. At all times though, students instructed in an autonomy-supportive style were more autonomously motivated than students instructed in a controlling style. Furthermore, results showed a positive effect of an autonomy-supportive instructional style on students’ functional state and their interest in continuing with the learning activity. The pattern of changes in relative autonomous motivation might indicate that in controlling conditions a reduction of dissonance is of functional importance, which is why relative autonomous motivation increased under controlling conditions but not under autonomy-supportive conditions. In an applied perspective, the study demonstrates that executing an activity might be beneficial for fostering autonomous motivation and it corroborates findings that indicate positive effects of an autonomy-supportive instructional style on students’ motivation and functional state. (shrink)

Although prior research has demonstrated that switching schools poses a risk for academic and behavioral functioning among adolescents, relatively little is known about their emotional adjustment, or how it affects emotional well-being. Moreover, the cumulative effects of multiple risk and protective factors on their emotional well-being are even less covered in the existing literature. Guided by a risk and resilience ecological framework, the current study compared emotional well-being, operationalized as positive affect and negative affect, between adolescents who had switched schools (...) and their non-switch counterparts, and examined the direct and interactive effects of teacher autonomy support and two facets of grit (i.e., perseverance and consistency) on emotional well-being in both groups. A propensity score matching analysis was used to balance the two groups in terms of sociodemographic characteristics (i.e., age, gender, and socioeconomic status). A total of 371 adolescents who had switched schools and 742 non-switch counterparts aged from 13 to 18 years were involved in this study. Results indicated that adolescents who had switched schools reported higher levels of negative affect than their non-switch counterparts. Moreover, for adolescents who had switched schools, those who possessed higher levels of perseverance had a significantly negative association between teacher autonomy support and negative affect; however, the corresponding association was independent of perseverance for their non-switch counterparts. The current findings indicate that switching schools is a disadvantage for adolescents’ emotional states. However, teacher autonomy support and perseverance can protect adolescents who switch schools as critical stress-buffering factors against these negative feelings. (shrink)

The COVID-19 pandemic has exacerbated levels of stress and anxiety for P-12 teachers around the globe. The present study aims to understand teachers’ emotional experiences and feelings of burnout during the pandemic, and how individual or contextual factors intersect with different facets of their emotional experiences. Using a sequential explanatory mixed methods design, we collected and examined survey and interview data from teachers in the southeastern United States. The structural equation model confirmed the relationships among the following latent variables: negative (...) emotion, emotion regulation, autonomy support, burnout, and teacher enthusiasm. Qualitative findings provide further insight in the contextualized nature of these relationships and how they play out across various schools and districts. (shrink)

Research increasingly demonstrates that associations between autonomy-relevant parenting and adolescent adjustment generalize across cultures. Yet, there is still an ongoing debate about the role of culture in these effects of autonomy-relevant parenting. The current study aimed to contribute to a more nuanced perspective on this debate by addressing cultural variability in micro-processes involved in autonomy-relevant parenting and, more specifically, in adolescents’ appraisals of and responses to parental behavior. In this vignette-based experimental study, involving 137 South-Korean adolescents (54% (...) female, mean age = 16 years), we examined whether individual differences in vertical collectivism affect the association between descriptions of potentially autonomy-supportive and controlling parenting practices and (a) appraisals of these practices (in terms of perceived autonomy support and control and experiences of autonomy need satisfaction and frustration), and (b) anticipated responses to these practices (i.e., negotiation, submissive compliance, and oppositional defiance). Participants in the autonomy-supportive condition reported more perceived autonomy support and autonomy satisfaction and lower perceived control and autonomy need frustration than participants in the controlling condition. Collectivism moderated between-vignette effects on perceived control and autonomy need frustration such that the differences between the autonomy-supportive and controlling vignettes were less pronounced (yet still significant) among adolescents scoring higher on collectivism. Collectivism did not moderate effects of the vignettes on the responses to parenting, but yielded a main effect, with collectivism relating to more submissive compliance and less oppositional defiance. Overall, the results suggest that both universal and culture-specific processes are involved in autonomy-relevant socialization. (shrink)

This study makes an original contribution to knowledge by investigating the impact of Just-in-Time teaching and peer instruction strategies on the promotion of students’ achievement, interaction, and motivation in English language learning. Students were recruited from an undergraduate TESOL program in the first semester of 2019 at a University in Saudi Arabia. A multiple method research design was used to address the research questions robustly and rigorously. First, a two-group quasi-experimental design was implemented. In the first group, a lecture-based strategy (...) was used, while in the second group, JiT and PI strategies were used in English language lessons. An innovative research method was used in this study: a private Instagram account was created, serving as a platform through which teacher and students could communicate using interactive posts and comments. Second, students filled out a survey reflecting on this medium of language teaching and learning. Finally, focus group interviews were conducted to determine students’ views on the use of Instagram as an educational tool in terms of its flexibility and usefulness. The findings of the study suggest that JiT teaching, and PI promoted students’ achievement and enhanced students’ motivation, particularly in relation to fluency and novelty in the second language. Furthermore, students viewed Instagram as a successful educational tool that significantly facilitated their collaboration. Nevertheless, this study also highlights the challenges of using JiT teaching and PI to facilitate language learning. Suggestions for practitioners are specified; including providing adequate e-learning tools for students to enhance language learning motivation and achievement. (shrink)

Promoting the use of contact tracing technology will be an important step in global recovery from the COVID-19 pandemic. Across two studies, we assessed two messaging strategies as motivators of intended contact tracing uptake. In one sample of 1117 Australian adults and one sample of 888 American adults, we examined autonomy-supportive and controlling message framing and the presence or absence of information safety as predictors of intended contact tracing application uptake, using an online randomized 2 × 2 experimental design. (...) The results suggested that the provision of data safety assurances may be key in affecting people’s intentions to use contact tracing technology, an effect we found in both samples regardless of whether messages were framed as autonomy-supportive or controlling. Those in high information safety conditions consistently reported higher intended uptake and more positive perceptions of the application than those in low information safety conditions. In Study 2, we also found that perceptions of government legitimacy related positively to intended application uptake, as did political affiliation. In sum, individuals appeared more willing to assent to authority regarding contact tracing insofar as their data safety can be assured. Yet, public messaging strategies alone may be insufficient to initiate intentions to change behavior, even in these unprecedented circumstances. (shrink)

Autonomy has been central to moral and political philosophy for millenia, and has been positioned as a critical aspect of both justice and wellbeing. Research in psychology supports this position, providing empirical evidence that autonomy is critical to motivation, personal growth and psychological wellness. Responsible AI will require an understanding of, and ability to effectively design for, human autonomy (rather than just machine autonomy) if it is to genuinely benefit humanity. Yet the effects on human (...) class='Hi'>autonomy of digital experiences are neither straightforward nor consistent, and are complicated by commercial interests and tensions around compulsive overuse. This multi-layered reality requires an analysis that is itself multidimensional and that takes into account human experience at various levels of resolution. We borrow from HCI and psychological research to apply a model (“METUX”) that identifies six distinct spheres of technology experience. We demonstrate the value of the model for understanding human autonomy in a technology ethics context at multiple levels by applying it to the real-world case study of an AI-enhanced video recommender system. In the process we argue for the following three claims: 1) There are autonomy-related consequences to algorithms representing the interests of third parties, and they are not impartial and rational extensions of the self, as is often perceived; 2) Designing for autonomy is an ethical imperative critical to the future design of responsible AI; and 3) Autonomy-support must be analysed from at least six spheres of experience in order to approriately capture contradictory and downstream effects. (shrink)

This study investigates the relationship between motivation, goal orientation, and perceived autonomy support from the coach among junior elite hockey players. The study is based upon the theory of self-determination and the goal orientation theory. The first aim of the study was to investigate whether high scores on task involvement and perceived autonomy support from the coach may explain the intrinsic motivation of the players. Secondly, we sought to discover whether the most autonomous extrinsic motives may (...) be explained by high scores on task involvement and perceived autonomy support from the coach. Lastly, we investigated whether the most controlling extrinsic motives may be explained by greater ego involvement or by both ego and task involvement and less perceived autonomy support from the coach. A total of 401 players aged 14–18 took part in the survey. The results show that intrinsic motivation can be explained by high scores on both task and ego involvement. The two most autonomous extrinsic motives—integrated and identified regulation—were both explained by task and ego involvement and perceived autonomy support from the coach. The two most controlled motives—introjected and external regulation—were both explained by high scores on task and ego involvement. (shrink)

This study investigated new avenues for understanding the association between parental autonomy support and academic engagement among Chinese secondary vocational students based on Self-Determination Theory and Career Construction Theory. We highlighted the mediator role of career adaptability and career decision-making self-efficacy in the relationship between parental autonomy support and academic engagement. Using self-reported data from 1,930 secondary vocational students in a city in Central China, we performed correlation analysis and mediation analysis by using SPSS and Mplus. (...) The results revealed that parental autonomy support was positively associated with students’ academic engagement. Moreover, as an adaptability resource and adapting response, career adaptability and career decision-making self-efficacy played mediating roles between parental autonomy support and academic engagement. These findings offered crucial empirical evidence for understanding the association between parental support and academic engagement among Chinese secondary vocational students. Meanwhile, it also validated the application of Career Construction Theory in a sample of secondary vocational students in China and provided constructive insights for implementing diverse support measures to boost their academic and career development. (shrink)

Two linked studies explored whether students’ perceptions differentiate between teachers’ autonomy support and control when presenting mastery goals, and the outcomes of these two practices, in terms of students’ internalization of mastery goals and their behavioral engagement. In two phases, Study 1 sought to validate a new instrument assessing students’ perceptions of teachers’ autonomy support and control when presenting mastery goals. Study 2 demonstrated that at both within- and between-classroom levels, perceptions of teachers’ autonomy (...) class='Hi'>support for mastery goals were related to students’ mastery goals’ endorsement and behavioral engagement. These relations were mediated by students’ autonomous reasons to pursue learning activities. Perceptions of teachers’ control predicted disengagement through controlled reasons for learning, but only at the within-classroom level. This research joins a growing body of work demonstrating that combining achievement goal theory with SDT can further our understanding of the underpinnings of achievement motivation. It suggests that if teachers want their students to endorse mastery goals, they need to use more autonomy supportive practices and less controlling ones. (shrink)

Although previous work has linked parent autonomy support to the development of children’s executive function skills, the role of specific autonomy-supportive behaviors has not been thoroughly investigated. We compiled data from four preschool-age samples in the Midwestern United States to examine three relevant autonomy-supportive behaviors and their associations with child EF. We coded parent autonomy-supportive behaviors from a 10-min interaction between parent and child dyads working on challenging jigsaw puzzles together. Children completed a battery of (...) EF. Overall, child EF was most consistently correlated with the offering choice subscale. Additionally, only the offering choice subscale predicted child EF while controlling for the other autonomy support subscales and child age. These results suggest that parent provision of choice is an especially relevant aspect of autonomy-supportive parenting and may be important to the development of EF in early childhood. Future research should directly measure children’s experience with choice and how it relates to emerging EF. (shrink)

Recently, more attention has been paid to the nature and value of the intellectual virtue of epistemic autonomy. One underexplored issue concerns how epistemic autonomy is related to other intellectual virtues. Plausibly, epistemic autonomy is closely related to a number of intellectual virtues like curiosity, inquisitiveness, intellectual perseverance, and intellectual courage to name just a few. Here, however, I will examine the relation between epistemic autonomy and intellectual humility. I will argue that epistemic autonomy and (...) intellectual humility bear an interesting relationship to one another in that they are interconnected and mutually supporting intellectual virtues. In sections 2 and 3 I will provide a brief overview of the predominant accounts of intellectual humility (section 2) and epistemic autonomy (section 3) in the literature. With an understanding of these intellectual virtues in hand, we will examine their relationship of mutual support in section 4. Section 5 will explore a challenge to this relationship coming from the epistemology of disagreement, and section 6 concludes. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood (...) and upheld in the context of rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood (...) and upheld in the context of rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients’ autonomy was found to be helpful for restoration of their autonomy. Two patterns in (...) health professionals’ approach appeared to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients’ progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients’ preparation for autonomous living after discharge. (shrink)

This commentary on “Her Own Decision: Impairment and Authenticity in Adolescence” by Campbell, Derrington, Hester, and Lew adds further consideration of obligations for guardians and physicians of minors who struggle in making serious decisions regarding medical treatment.

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the (...) necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research. (shrink)

In their article, “Supported Decision Making with People at the Margins of Autonomy,” Peterson, Karlawish, and Largent point to the fact that the concept of ‘supported decision-making’ has recently...

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Article 12 (Equal Recognition before the Law) of the UN Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities: the recognition of legal capacity. Legal capacity means recognizing the right to make decisions for oneself. Article 12 is also moving in the direction of supported decision-making, as an alternative to (...) substituted decision-making. The objective of this paper is to show conceptually the connection between supported decisionmaking and the preservation of personal autonomy for persons with intellectual disabilities. This paper discusses supported decision-making based on Bach and Kerzner's model: (a) legally independent status, (b) supported decision- making status, and (c) facilitated decision-making status. Arguments will be made based on John Stuart Mill's concept of autonomy and arguments against it using Sarah Conly's argument for paternalism. (shrink)

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Adults with intellectual disabilities are characterized by the limitations in their intellectual functioning and in their adaptive behavior, which compromises three skill types, and this starts before the age of 18. Though persons with intellectual disabilities are characterized by having these limitations, they are thought to face significant decisionmaking challenges due to their disability. Moving away from this (...) generalization, Article 12 of the United Nations Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities, recognizing the right to legal capacity. (shrink)

Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it (...) is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base. (shrink)

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

Supported decision making is a model of decision making in which an adult with impaired capacity enters freely into an agreement with a closely trusted person or persons (the “s...

A liberal state based on propositions about the desirability of individual autonomy is bound to be committed to educational programmes which are incompatible with the beliefs and values of parents from non- liberal religious and cultural minorities. One response to this has been support for public funding of those separate schools which offer an education culturally congruent with the values of parents in non- liberal communities. To resolve the potential threat to liberal individualist ideals a condition of (...) class='Hi'>support for individual autonomy is usually attached to liberal acceptance of this solution. This condition is in conflict with the motivation which underpins the setting up of such schools. Despite the growing literature on this debate surprisingly little attention has been given to the work of Isaiah Berlin. This article draws on Berlin's version of liberalism developed within the context of a commitment to value pluralism in order to seek clarification of this liberal dilemma. (shrink)

We join McCarthy and Howard (2023) in advocating supported decision-making for patients with diminished mental capacity that meaningfully expands the role of trustees beyond merely channeling the i...

Susan Sherwin's approach to bioethics promotes more inclusive and less oppressive sociopolitical environments within healthcare for marginalized groups. Sherwin's relational theory of autonomy endorses this aim in targeting live options as bellwethers for recognizing contexts constraining or promoting autonomy. Those contexts closing off certain options as pursuable in practice limit autonomy while those promoting a plurality of practically pursuable courses of action are autonomy enhancing. Attending to what is possible in practice is thus key to understanding (...) how autonomy is impacted. In healthcare contexts, those implicated in social structures systematically limiting autonomy sustain oppressive contexts... (shrink)

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations (...) warrant research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent (...) bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity. (shrink)

Amy E. Caruso Brown (2022) considers situations in which a minor child’s parent or legal guardian (the “marginalized decision-maker (MDM)”) defers to another individual (the “primary decision-maker...

The medical developments and their subsequent influence on the duration of human life have brought in the limelight various moral questions. The pathological conditions do not constitute anymore the decisive causes of death, whereas an ascending number of people suffer more by being maintained in life. In this reality, the euthanasia debate seems more apropos than ever. The following article examines the aforementioned issue through the supportive argument of autonomy in contrast to a Foucauldian approach. In essence, based on (...) the Kantian concept of autonomy, several scholars have advocated in favor of the legalization of euthanasia in order that our ability to define not only the course of our life and its duration, but also the way of our death is ensured. However, on the other side, a Foucauldian approach of the issue seems to be equally worth cited and taken into consideration. In accordance with that, the domination of Foucault's concept of biopower would deterministically imply that our choices are totally determined by a form of power that targets at the absolute control over our lives through medicine and legislation. In such a context, euthanasia could not constitute a promoter of autonomy. On the contrary, it would contribute to the absolute escalation of the governmental power that would be imposed on every inch of our lives being exclusively interested in its own prosperity! (shrink)